Peds exam 1- Endocrine concerns

The structure and function of the endocrine system

• control and regulation of metabolism:

  • energy production

  • growth

  • fluid and electrolyte balance

  • response to stress

  • sexual reproduction

Endocrine glands throughout the body

• hypothalamus

• pineal

• pituitary

• thyroid

• parathyroids

• thymus

• adrenals

• islets of langerhans

• ovaries

• testies

Pituitary hormones- anterior

• adrenocorticotropic- adrenal cortex

• LH and FSH- testicle and ovaries

• Prolactin- breast

• Thyroid-stimulating - thyroid

• Melanocyte-stimulating - skin

• growth- bone

pituitary hormones- posterior

• antidiuretic- kidney

• oxytocin- uterus and breast

What is growth hormone’s action?

pituitary → bones → promotes growth of bone and soft tissues

What is gonadotropic hormone’s action?

Pituitary- Gonads- produce sex hormones, stimulate gonads to mature

What is insulin and glucagon’s action?

Pancreas → liver and blood cells → controls blood sugar levels

What is ADH’s action?

Hypothalamus → kidneys → controls body fluids

Precocious puberty

• before age 8 in people assigned female at birth

• before age 9 in those assigned male at birth

• increases sexual characteristics, not sex drive; “puberty before puberty onset”

• central precocious puberty

  • most common form

  • cause: premature activation of hypothalamic-pituitary-gonadal axis

• what is it?

  • development of sexual characteristics before usual age of pubertal onset

  • idiopathic 95% of time

  • more common in those assigned female at birth

• how do we diagnose it?

  • history

  • physical exam

  • GnRH stimulation test

  • hormone labs

  • bone age

How to treat precocious puberty

• puberty blockers

• (GnRH analogues, suppress the release of gonadotropin)

• education

• why do we treat?

  • psychosocial consequences

  • stature concerns

• in 50% of cases- progression halts on its own without treatment

• sexual interest not advanced beyond the chronological age

Nursing care: Puberty and Physical development

• health history and physical exam

  • development of secondary sex characteristics

  • genital development (males)

  • growth of pubic hair

Premature thelarche:

• development of breasts in prepubertal girls

Premature menarche:

• isolated menses without other evidence of sexual development

Premature pubarche/ adrenarche:

• early development of sexual hair

Tanner staging (Sexual maturity ratings- SMR)

• stage 1:

  • male: testicular volume <3ml

  • pubic hair: no pubic hair

  • breast: elevation of papilla only

• stage 2:

  • male: testicular volume <3 ml, change in texture to scrotal skin

  • pubic hair: sparse growth chiefly along the labia/ base of penis

  • breast: breast bud stage

• stage 3:

  • male: increase in size of penis with further testicular enlargement

  • pubic hair: darker, coarser, more curled hair

  • breast: enlargement of breast and areola

• stage 4

  • male: further enlargement of penis and testicles with development of glans penis

  • pubic hair: adult type hair over a smaller area

  • breast: projection of the areola and papilla

• stage 5:

  • male: adult size and shape

  • pubic hair: spread to the medial surface of the thighs

  • breast: recession of the areola to the contour of the breast, projection of papilla only